Abstract 14804: Meta-Analysis of Long Term Outcomes of Intravascular Ultrasound versus Angiographic-Guided Percutaneous Coronary Intervention of Bifurcation Lesions
Objectives: To compare differences in long term outcomes in intravascular ultrasound (IVUS)-guided vs. angiography-guided percutaneous coronary interventions (PCI) of bifurcation lesions.
Background: Bifurcation lesions are common, and bifurcation PCI is associated with worse outcomes, including target lesion failure and stent thrombosis (ST). There is limited data on whether IVUS guidance can improve outcomes compared to angiographic guidance only in bifurcation PCI.
Methods: We conducted a meta-analysis of studies that reported long-term outcomes in IVUS-guided vs. angiography-guided bifurcation PCI.
Results: Five observational studies with 7,123 patients were included for analysis. Mean follow-up time was 28.1 months for IVUS-guided PCI, and 25.7 months for angiography-guided PCI. Drug eluting stents were used in most cases (80.1%), and left main PCI was uncommon (9.3%). Patients undergoing IVUS-guided PCI were more commonly treated with a two stent technique compared to angiography-guided PCI (43.2% vs. 35.0%), had a larger main vessel mean stent diameter (standardized mean difference [SMD] 0.29 mm, 95% confidence interval [CI] 0.22-0.35, p <0.001), and larger side branch stent diameters (SMD 0.38mm, 95% CI 0.27-0.49, p <0.001). IVUS-guided PCI was associated with a significant reduction in the composite of death, myocardial infarction (MI), and ST (6.9% vs. 12.0%, odds ratio [OR] 0.137, 95% CI 0.023-0.825, p = 0.030, Figure ). IVUS-guided PCI was also associated with a significant reduction in death (OR 0.519, 95% CI 0.373-0.722, p<0.001) and stent thrombosis (OR 0.218, 95% CI 0.053-0.891, p=0.034) compared to angiography- guided PCI. There was no difference in target lesion revascularization with IVUS-guided PCI compared to angiography-guided PCI.
Conclusions: IVUS-guided bifurcation PCI may improve long term outcomes compared to angiography-guided bifurcation PCI. Randomized data are needed to confirm the findings of this meta-analysis.
- © 2013 by American Heart Association, Inc.